Method for detecting an increased risk or incidence of colorectal cancer

ABSTRACT

The present invention relates to the methods and products for detection of colorectal cancer. Additionally, the present invention relates to methods and products for determining the probability, risk or incidence of colorectal cancer and of colorectal cancer metastasis. The products and methods of the present invention include detecting the level of expression of COL10A1 or MMP11, in combination, from samples, including tissue samples, from humans who currently have been diagnosed with cancer or who were previously diagnosed with cancer and those who are thought to have cancer and are undergoing diagnosis.

RELATED APPLICATIONS

The present application claims the benefit of U.S. patent applicationSer. No. 15/250,593 filed Aug. 29, 2016, which claims the benefit ofU.S. patent application Ser. No. 14/433,080 filed on Apr. 2, 2015, whichis the US national stage of International Application No.PCT/US2013/062581 filed on Sep. 30, 2013, which claims priority to theU.S. provisional application No. 61/710,090, filed Oct. 5, 2012. All ofthe contents of these applications are incorporated herein by referencein their entirety.

This application incorporates by reference the sequence listing which issubmitted together with this application in computer readable form whichhas the file name SL_2012P23093US02_ST25.txt and is 18 KB.

BACKGROUND

Colorectal cancer (CRC) is the third most common neoplasm worldwide. Themortality rate of newly diagnosed large bowel cancer approaches 50% andthere has been little improvement over the past 40 years. Most of thismortality reflects local, regional and distant metastases.

Early detection of primary, metastatic, and recurrent disease cansignificantly impact the prognosis of individuals suffering fromcolorectal cancer. Large bowel cancer diagnosed at an early stage has asignificantly better outcome than that diagnosed at more advancedstages. Similarly, diagnosis of metastatic or recurrent disease earlierpotentially carries with it a better prognosis.

SUMMARY

COL10A1 and MMP11 expression in colorectal carcinoma primary tumors isassociated with metastatic disease.

The present invention relates to the methods and products for detectionof a disease, including cancer, including colon cancer, rectal cancer orcolorectal cancer. Additionally, the present invention relates tomethods and products for determining the probability, risk or incidenceof a disease, such as cancer recurrence or metastasis in humans havingcancer, including colon cancer, rectal cancer or colorectal cancer.Additionally, the present invention relates to methods and products fordetermining the probability, risk or incidence of metastasis in humanshaving cancer, including colon cancer, rectal cancer or colorectalcancer. The products and methods of the present invention includedetecting the level of expression of COL10A1 or MMP11, individually orin combination, from samples, including tissue samples (e.g., from aprimary tumor), from humans who currently have been diagnosed withcancer or who were previously diagnosed with cancer and those who arethought to have cancer and are undergoing diagnosis. The presentinvention additionally includes determining treatment options, includingpharmaceutical and surgical treatment options, based on the probability,risk or incidence of disease recurrence, presence or metastasis,including instruction or administration of a particular drug based onthe outcome.

In some embodiments, methods for identifying or characterizingindividuals at risk of or suffering from colorectal cancer are providedthat comprise providing a sample from an individual whose risk orincidence of colorectal cancer is to be identified or characterized,processing the sample to determine a level of COL10A1 and a level ofMMP11, and classifying the individual as having an elevated risk orincidence of colorectal cancer if the levels of COL10A1 and MMP11 areboth elevated relative to a reference. In some embodiments, the samplecomprises human RNA. In some embodiments, the sample comprises humancDNA. In some embodiments, the step of processing comprises performing aPCR amplification of nucleic acids present in the sample. In certainembodiments, the step of processing comprises performing a reversetranscriptase PCR amplification of nucleic acids present in the sample.In some embodiments, the reverse transcriptase PCR amplification isquantitative. In certain embodiments, the step of processing comprisesperforming a microarray analysis of nucleic acids present in the sample.In some embodiments, the method further comprises administering to theindividual a therapeutically effective amount of an agent for treatingincidence and/or risk of colorectal cancer.

In some embodiments, methods of treating individuals at risk of orsuffering from colorectal cancer are provided that compriseadministering to the individual a therapeutically effective amount of anagent for treating incidence and/or risk of colorectal cancer, wherein asample from the individual has previously been determined to contain anelevated level of both COL10A1 and MMP11 relative to a reference. Insome embodiments, the sample comprises human RNA. In some embodiments,the sample comprises human cDNA.

In some embodiments, according to the methods presented herein, theindividual comprises a human having colorectal cancer in stage UICC I.In some embodiments, the individual comprises a human having colorectalcancer in stage UICC II. In certain embodiments, the risk or incidenceof colorectal cancer comprises a risk of progressing to stage UICC IIIand/or IV. In some embodiments, the risk or incidence of colorectalcancer comprises a risk or incidence of colorectal cancer metastasis. Incertain embodiments, the risk or incidence of colorectal cancercomprises a risk or incidence of colorectal cancer recurrence.

In some embodiments, according to the methods presented herein, thesample comprises human tumor tissue. In some embodiments, the sample isobtained from a primary colorectal tumor.

In some embodiments, according to the methods presented herein, thereference comprises a historical reference level of COL10A1 and MMP11from the individual whose risk or incidence of colorectal cancer is tobe identified or characterized. In some embodiments, the referencecomprises levels of COL10A1 and MMP11 in a sample from an individualwith a known risk or incidence of colorectal cancer.

In some embodiments, kits for classifying individuals as having anelevated risk of or suffering from colorectal cancer are provided thatcomprise primers for amplifying a region of COL10A1 and primers foramplifying a region of MMP11. In some embodiments, the kit furthercomprises probes for detecting both COL10A1 and MMP11. In someembodiments, the kit further comprises amplification reagents. In someembodiments, amplification reagents are selected from the groupconsisting of polymerase, reverse transcriptase, nNTPs, Mg⁺, andcombinations thereof. In some embodiments, the kit further comprises apositive control. In certain embodiments, the kit further comprising anegative control. In some embodiments, the kit further comprises apositive and negative control.

In some embodiments, a non-transitory computer readable mediumcontaining executable instructions that when executed cause a processorto perform operations is provided that comprises receiving anindividual's levels of COL10A1 and MMP11, determining whether theindividual possesses elevated levels of COL10A1 and MMP11 relative to areference, and classifying the individual as at risk of or sufferingfrom colorectal cancer if the individual possesses elevated levels ofCOL10A1 and MMP11. In some embodiments, the non-transitory computerreadable medium further comprises executable instructions that whenexecuted cause a processor to perform operations that comprise assigninga colorectal cancer classification identifier to the individual based onthe levels of COL10A1 and MMP11, and outputting a list of colorectalcancer classifications of the individual. In some embodiments, thenon-transitory computer readable medium further comprises instructionsthat when executed cause the processor to execute a step of ranking thecolorectal cancer classifications before outputting the list ofcolorectal cancer classifications of the individual. In certainembodiments, the ranking is adjusted based on receiving a clinicalresponse relating to the individual.

In some embodiments, a non-transitory computer readable mediumcontaining executable instructions that when executed cause a processorto perform operations is provided that comprises receiving anindividual's levels of COL10A1 and MMP11, determining whether theindividual possesses elevated levels of COL10A1 and MMP11 relative to areference, and classifying the individual as one that could benefit fromtherapy with an agent if the individual possesses elevated levels ofCOL10A1 and MMP11. In some embodiments, the non-transitory computerreadable medium further comprises executable instructions that whenexecuted cause a processor to perform operations that comprise assigninga treatment identifier to the individual based on the elevated levels ofCOL10A1 and MMP11, and outputting a list of agents suitable foradministering to the individual. In some embodiments, the non-transitorycomputer readable medium further comprises instructions that whenexecuted cause the processor to execute a step of ranking the agentsbefore outputting the list of agents suitable for administering to theindividual. In certain embodiments, the ranking is adjusted based onreceiving a clinical response relating to the individual.

BRIEF DESCRIPTION OF THE DRAWING

FIGS. 1A-1F shows molecular markers of metastatic CRC as determined bymicroarray analysis. Box-plots (Figures A-E, left) and ROC analyses(Figures A-E, right) of gene expression of ABDH2 (A), COL10A1 (B), MMP11(C), C8orf30A (D) and SLC35D1 (E) are shown. RNA was extracted fromprimary tumors in non-metastatic Union for International Cancer Control(UICC) stages I and II (n=40) and in metastatic stage UICC III (n=40). Pvalues and areas under curve (AUC) are shown. Correlation analyses werecarried out using scatterplot matrices and Spearman's rho values (F).

FIGS. 2A-2F shows molecular markers of metastatic CRC as determined by aretrospective analysis using automated RNA extraction fromformalin-fixed paraffin-embedded FFPE tissues and quantitative real timepolymerase chain reaction (qRT-PCR). Box-plots (Figures A-E, left) andROC analyses (Figures A-E, right) of gene expression of ABDH2 (A),COL10A1(B), MMP11 (C), C8orf30A (D) and SLC35D1 (E) as determined bymicroarray analyses. RNA was extracted from 82 patients with primarytumors in different stages [UICC I (n=17), UICC II (n=24), UICC III(n=20), UICC IV (n=21), Table 3]. An automated extraction method for RNAfrom FFPE tissue sections and subsequent quantitative RT-PCR wereapplied. P values and AUC are shown. Correlation analyses were carriedout using scatterplot matrices and Spearman's rho values (F).

FIGS. 3A-3F shows molecular markers of metastatic CRC as determined by aprospective validation study using automated RNA extraction from FFPEtissues and qRT-PCR. Box-plots (Figures A-E, left) and ROC analyses(Figures A-E, right) of gene expression of ABDH2 (A), COL10A1 (B), MMP11(C), C8orf30A (D) and SLC35D1 (E) as determined by microarray analyses.RNA was extracted from 153 patients with different stages of colorectalcarcinoma [UICC I (n=42), UICC II (n=44), UICC III (n=36), UICC IV(n=33)]. An automated extraction method for RNA from FFPE tissuesections and subsequent quantitative RT-PCR were applied. P values andAUC are shown. Correlation analyses were carried out using scatterplotmatrices and Spearman's rho values (F).

FIGS. 4A-4D shows stage related expression and association to recurrencein stage UICC II CRC of COL10A1 and MMP11. Waterfall plots of expressionand stage are given for COL10A1 (A) and MMP11 (B). Tumor stages areindicated. Expression of COL10A1 (C) and MMP11 (D) in 20 patients ofstage UICC II as determined by microarray analysis and in relation tothe development of distant metastasis after primary treatment during thefollow up period. Patients with recurrent disease (relapse) areindicated.

FIG. 5A contains panels A-F, and FIG. 5B contains panels G-L. FIGS. 5Aand 5B show expression of collagen X and MMP11 at the protein level incolorectal carcinoma. Immunohistochemistry was performed on CRC specimenwhich exhibited in the prospective validation study either high or lowRNA expression of the respective factors at the RNA level as indicated.Staining of the same specimen with the different antibodies were carriedout on consecutive sections. High expression of collagen 10A1 wasdetected in panels B and H (arrows) and of MMP11 in panels D and K(arrows). Low expression was observed for collagen 10A1 in (A) and (G)and of MMP 11 in (E) and (J). Normal mucosa of the respective patientsshowed always lower signal intensities for both proteins (C, F). Controlstainings of CRC tissues with an isotype antibody were negative (I, L).

FIG. 6 depicts an exemplary block diagram of a computer system 100.

FIG. 7 depicts an exemplary flow chart of a method 200 for building adatabase for use in selecting a medication and/or colorectal cancerclassification for a patient.

FIG. 8 depicts an exemplary flow chart of a method 300 for selectingmedication and/or a colorectal cancer classification for a patient.

DEFINITIONS

Agents: As used herein, the term “agents” refers to any compounds orcompositions that act as modulators of colorectal cancer susceptibilityor progression. In general, agents can be of any chemical classincluding, for example, polypeptides, nucleic acids, saccharides,lipids, small molecules, metals, or combinations thereof. In someembodiments, agents can be or comprise cells or organisms, or anyfraction, extract, or component thereof. In some embodiments, agents arenatural products in that they are found in and/or obtained from nature.In some embodiments, agents are man-made in that they are designed,engineered, and/or produced through action of the hand of man and/or arenot found in nature. In some embodiments, agents are utilized inisolated or pure form; in some embodiments, agents are utilized in crudeform. In some embodiments, potential agents are provided as collectionsor libraries, for example that may be screened to identify active agentswithin them. Some particular embodiments of agents that may be utilizedin accordance with the present invention include small molecules,antibodies, antibody fragments, aptamers, siRNAs, shRNAs, DNA/RNAhybrids, antisense oligonucleotides, ribozymes, peptides, peptidemimetics, polymers etc.

Antibody: As used herein, the term “antibody” refers to animmunoglobulin, or an antigen-binding fragment (e.g., Fab, Fab′,F(ab′)2, etc.) or derivative (e.g., s scFv, Fv, dsFv diabody, Fd). Insome embodiments, an antibody is monoclonal. In some embodiments, anantibody is polyclonal. In some embodiments, an antibody is or comprisesa polypeptide whose amino acid sequence includes all or a characteristicportion of an immunoglobulin constant domain (e.g., of an IgG, IgM, IgA,IgD, or IgE constant domain); in some such embodiments, the constantdomain is a human constant domain. In some embodiments, an antibody isor comprises a polypeptide whose amino acid sequence includes all or acharacteristic portion of an immunoglobulin variable domain; in somesuch embodiments the variable domain comprises CDR1, CDR2, and/or CDR3sequence elements sufficient to permit and achieve specific binding toan antigen. In some such embodiments, one or more of such CDR1, CDR2,and CDR3 sequence elements is a human element. In some embodiments, anantibody is produced by synthesis. In some embodiments, an antibody isproduced by a cell or cell line (e.g., a hybridoma). In someembodiments, an antibody is produced by an organism.

Associated With: The term “associated with” is used herein to describean observed correlation between two items or events. For example,elevated expression of COL10A1 and MMP11 may be considered to be“associated with” colorectal cancer if its elevated expressioncorrelates with a presence of colorectal cancer.

Carrier: As used herein, the term “carrier” refers to a pharmaceuticallyacceptable (e.g., safe and non-toxic for administration to a human)carrier substance useful for preparation of a pharmaceuticalformulation. In many embodiments, a carrier is biologicallysubstantially inert, e.g., so that activity of a biologically activesubstance is not materially altered in its presence as compared with inits absence. In some embodiments, a carrier is a diluent.

Comparable: The term “comparable” as used herein refers to a system, setof conditions, effects, or results that is/are sufficiently similar to atest system, set of conditions, effects, or results, to permitscientifically legitimate comparison. Those of ordinary skill in the artwill appreciate and understand which systems, sets of conditions,effect, or results are sufficiently similar to be “comparable” to anyparticular test system, set of conditions, effects, or results asdescribed herein.

Dosage form: As used herein, the terms “dosage form” and “unit dosageform” refer to a physically discrete unit of a therapeutic compositionfor administration to a subject to be treated. Each unit dosage formcontains a predetermined quantity of active agent calculated to producea desired therapeutic effect when administered in accordance with adosing regimen. It will be understood, however, that a total dosage ofthe active agent may be decided by an attending physician within thescope of sound medical judgment.

Dosing regimen: A “dosing regimen” (or “therapeutic regimen”), as thatterm is used herein, is a set of unit doses (typically more than one)that are administered individually to a subject, typically separated byperiods of time. In some embodiments, a given therapeutic agent has arecommended dosing regimen, which may involve one or more doses.

Gene: The term “gene”, as used herein, has its art understood meaning,and refers to a part of the genome specifying a macromolecular product,be it DNA for incorporation into a host genome, a functional RNAmolecule or a protein, and may include regulatory sequences (e.g.,promoters, enhancers, etc.) and/or intron sequences preceding (5′non-coding sequences).

Nucleic Acid: The terms “nucleic acid”, “nucleic acid molecule”, and“polynucleotide” each is used herein to refer to a polymers ofnucleotide monomers or analogs thereof, such as deoxyribonucleic acid(DNA) and ribonucleic acid (RNA). Unless otherwise stated, the termsencompass nucleic acid-like structures with synthetic backbones, as wellas amplification products.

Polypeptide: The term “polypeptide” or “peptide”, as used herein,generally has its art-recognized meaning of a polymer of at least threeamino acids. Those of ordinary skill in the art will appreciate that theterm “polypeptide” is intended to be sufficiently general as toencompass not only polypeptides having a complete sequence recitedherein, but also to encompass polypeptides that represent functionalfragments (i.e., fragments retaining at least one activity) of suchcomplete polypeptides. Moreover, those of ordinary skill in the artunderstand that protein sequences generally tolerate some substitutionwithout destroying activity. Thus, any polypeptide that retains activityand shares at least about 30-40% overall sequence identity, oftengreater than about 50%, 60%, 70%, or 80%, and further usually includingat least one region of much higher identity, often greater than 90% oreven 95%, 96%, 97%, 98%, or 99% in one or more highly conserved regions,usually encompassing at least 3-4 and often up to 20 or more aminoacids, with another polypeptide of the same class, is encompassed withinthe relevant term “polypeptide” as used herein.

Protein: The term “protein” as used herein refers to one or morepolypeptides that function as a discrete unit. If a single polypeptideis the discrete functioning unit and does not require permanent ortemporary physical association with other polypeptides in order to formthe discrete functioning unit, the terms “polypeptide” and “protein” maybe used interchangeably. If the discrete functional unit is comprised ofmore than one polypeptide that physically associate with one another,the term “protein” may be used to refer to the multiple polypeptidesthat are physically associated and function together as the discreteunit.

Primer: The terms “primer”, as used herein, typically refers tooligonucleotides that hybridize in a sequence specific manner to acomplementary nucleic acid molecule (e.g., a nucleic acid moleculecomprising a target sequence). In some embodiments, a primer willcomprise a region of nucleotide sequence that hybridizes to at leastabout 8, e.g., at least about 10, at least about 15, or about 20 toabout 40 consecutive nucleotides of a target nucleic acid (i.e., willhybridize to a contiguous sequence of the target nucleic acid). Ingeneral, a primer sequence is identified as being either “complementary”(i.e., complementary to the coding or sense strand (+)), or “reversecomplementary” (i.e., complementary to the anti-sense strand (−)). Insome embodiments, the term “primer” may refer to an oligonucleotide thatacts as a point of initiation of a template-directed synthesis usingmethods such as PCR (polymerase chain reaction) under appropriateconditions (e.g., in the presence of four different nucleotidetriphosphates and a polymerization agent, such as DNA polymerase in anappropriate buffer solution containing any necessary reagents and atsuitable temperature(s)). Such a template directed synthesis is alsocalled “primer extension”. For example, a primer pair may be designed toamplify a region of DNA using PCR. Such a pair will include a “forwardprimer” and a “reverse primer” that hybridize to complementary strandsof a DNA molecule and that delimit a region to be synthesized and/oramplified.

Reference: As will be understood from context, a reference sequence,sample, population, agent or individual is one that is sufficientlysimilar to a particular sequence, sample, population, agent orindividual of interest to permit a relevant comparison (i.e., to becomparable). In some embodiments, information about a reference sampleis obtained simultaneously with information about a particular sample.In some embodiments, information about a reference sample is historical.In some embodiments, information about a reference sample is stored forexample in a computer-readable medium. In some embodiments, comparisonof a particular sample of interest with a reference sample establishesidentity with, similarity to, or difference of a particular sample ofinterest relative to a reference. In some embodiments, a reference for amarker is based on levels measured in an individual or population ofindividuals (e.g., an average across the population of 5, 10, 20 or moreindividuals) who do not present with symptoms of the disease in question(e.g., colorectal cancer). In some embodiments, a reference for a markercomprises a historical reference level for the marker from theindividual being characterized.

Risk: As will be understood from context, a “risk” of a disease,disorder or condition (e.g., colorectal cancer) comprises a likelihoodthat a particular individual will develop the disease, disorder, orcondition. In some embodiments, risk is expressed as a percentage. Insome embodiments, risk is from 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 up to100%. In some embodiments risk is expressed as a risk relative to a riskassociated with a reference sample or group of reference samples. Insome embodiments, a reference sample or group of reference samples havea known risk of a disease, disorder, or condition. In some embodiments areference sample or group of reference samples are from individualscomparable to a particular individual. In some embodiments, relativerisk is 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 or more.

Sample: As used herein, the term “sample” typically refers to abiological sample obtained or derived from a source of interest, asdescribed herein. In some embodiments, a source of interest comprises anorganism, such as an animal or human. In some embodiments, a biologicalsample is or comprises biological tissue or fluid. In some embodiments,a biological sample may be or comprise bone marrow; blood; blood cells;ascites; tissue or fine needle biopsy samples; cell-containing bodyfluids; free floating nucleic acids; sputum; saliva; urine;cerebrospinal fluid, peritoneal fluid; pleural fluid; feces; lymph;gynecological fluids; skin swabs; vaginal swabs; oral swabs; nasalswabs; washings or lavages such as a ductal lavages or broncheoalveolarlavages; aspirates; scrapings; bone marrow specimens; tissue biopsyspecimens; surgical specimens; feces, other body fluids, secretions,and/or excretions; and/or cells therefrom, etc. In some embodiments, abiological sample is or comprises cells obtained from an individual. Insome embodiments, obtained cells are or include cells from an individualfrom whom the sample is obtained. In some embodiments, a sample is a“primary sample” obtained directly from a source of interest by anyappropriate means. For example, in some embodiments, a primarybiological sample is obtained by methods selected from the groupconsisting of biopsy (e.g., fine needle aspiration or tissue biopsy),surgery, collection of body fluid (e.g., blood, lymph, feces etc.), etc.In some embodiments, as will be clear from context, the term “sample”refers to a preparation that is obtained by processing (e.g., byremoving one or more components of and/or by adding one or more agentsto) a primary sample. For example, filtering using a semi-permeablemembrane. Such a “processed sample” may comprise, for example nucleicacids extracted from a sample or obtained by subjecting a primary sampleto techniques such as amplification, isolation and/or purification ofcertain components, etc.

Suffering from: An individual who is “suffering from” a disease,disorder, and/or condition has been diagnosed with or displays one ormore symptoms of the disease, disorder, and/or condition.

Therapeutically effective amount: As used herein, the term“therapeutically effective amount” refers to an amount of a therapeuticcomposition which confers a therapeutic effect on a treated subject, ata reasonable benefit/risk ratio applicable to any medical treatment. Atherapeutic effect may be objective (i.e., measurable by some test ormarker) or subjective (i.e., subject gives an indication of or feels aneffect). In particular, a “therapeutically effective amount” refers toan amount of a therapeutic composition effective to treat, ameliorate,or prevent a desired disease or condition, or to exhibit a detectabletherapeutic or preventative effect, such as by ameliorating symptomsassociated with a disease, preventing or delaying onset of a disease,and/or also lessening severity or frequency of symptoms of a disease. Atherapeutically effective amount is commonly administered in a dosingregimen that may comprise multiple unit doses. A therapeuticallyeffective amount (and/or an appropriate unit dose within an effectivedosing regimen) may vary, for example, depending on route ofadministration, combination with other agents, etc.

Treatment: As used herein, the term “treat,” “treatment,” or “treating”refers to any method used to partially or completely alleviate,ameliorate, relieve, inhibit, prevent, delay onset of, reduce severityof and/or reduce incidence of one or more symptoms or features of aparticular disease, disorder, and/or condition. Treatment may beadministered to a subject who does not exhibit signs of a disease and/orexhibits only early signs of the disease for the purpose of decreasingthe risk of developing pathology associated with the disease.

DETAILED DESCRIPTION OF CERTAIN EMBODIMENTS

Colorectal Cancer

Colorectal cancer is the third most common neoplasm worldwide. Themortality rate of newly diagnosed large bowel cancer approaches 50% andthere has been little improvement over the past 40 years. Most of thismortality reflects local, regional and distant metastases.

Colorectal cancer is a heterogeneous disease, consisting of tumorsthought to emerge through three major molecular mechanisms: 1) mutationsin the adenomatous polyposis coli (APC) gene, or the beta-catenin gene,combined with chromosomal instability, 2) mutations in DNA mismatchrepair genes, such as MLH1, MSH2, PMS1, PMS2 and MSH6, associated withmicrosatellite instability and mutations in genes containing shortrepeats, and 3) gene silencing induced by hypermethylation of thepromoter regions of tumor suppressor genes. The genetic complement ofindividual colorectal cancers is likely to include differentcombinations of genetic instability, specific mutations, and genesilencing. Chromosomal instability (CIN) is a common feature of cancersin general. It implies an aneuploid phenotype, in which wholechromosomes or large parts of them are being lost or gained.

Early detection of primary, metastatic, and recurrent disease cansignificantly impact the prognosis of individuals suffering fromcolorectal cancer. Large bowel cancer diagnosed at an early stage has asignificantly better outcome than that diagnosed at more advancedstages. Similarly, diagnosis of metastatic or recurrent disease earlierpotentially carries with it a better prognosis.

The invention presented herein comprises the recognition that theexpression of certain genes, COL10A1 and MMP11 can serve as an indicatorof increased risk or incidence of colorectal cancer.

COL10A1

Collagens are the major proteinaceous component of the extracellularmatrix of mammalian species. The primary role of collagen is to providea scaffold to support tissues, although a number of other functions havebeen elucidated for the collagens including roles in cell attachment,cell migration, filtration and morphogenesis. (Mays et al., BiochemicalJournal, 1991, 276:307-313). Collagens are a super-family of closelyrelated proteins sharing some common structural and functionalproperties, including triple-helical regions which have a repeatingtriplet of amino acids glycine-X-Y, where X is frequently proline and Yis often hydroxyproline. Hydroxyproline constitutes approximately 12%(w/w) of interstitial fibrillar collagens and is found in only a fewother proteins including the complement component C1 q, elastin, acetylcholinesterase, conglutinin, type I and type II macrophage scavengerreceptors, mannose-binding protein, pulmonary surfactant apolipoproteinsA and D, where its prevalence is much lower than in collagens. (Mays andLaurent, in “Molecular Biology of Lung Disease” (Barnes and Stockleyeds.) Blackwell Scientific Publishers, UK; 1994, pages 216-260.)Therefore, hydroxyproline is frequently used as an amino acid toidentify and quantify collagens. (Udenfriend, Science, 1966,152:1335-1340).

Currently, there are nineteen characterized collagens (designatedcollagens I to XIX). The gene COL10A1 encodes the protein collagenalpha-1(X) chain, the alpha chain of type X collagen. This type ofcollagen is typically expressed by hypertrophic chondrocytes duringendochondral ossification.

Collagen, type X, alpha 1 protein contains 680 amino acid residues.Exemplary amino acid and nucleotide sequences from a full-length humancollagen, type X, alpha 1 polypeptide are shown below as SEQ ID NOs: 1and 2.

TABLE 1 Human Collagen MLPQIPFLLLVSLNLVHGVFYAERYQMPTGIKGPLPNTKTQFFIPAlpha-1(X) Chain YTIKSKGIAVRGEQGTPGPPGPAGPRGHPGPSGPPGKPGYGSPGLPrecursor Protein QGEPGLPGPPGPSAVGKPGVPGLPGKPGERGPYGPKGDVGPAGLPSequence (NCBI GPRGPPGPPGIPGPAGISVPGKPGQQGPTGAPGPRGFPGEKGAPG ReferenceVPGMNGQKGEMGYGAPGRPGERGLPGPQGPTGPSGPPGVGKRGEN Sequence:GVPGQPGIKGDRGFPGEMGPIGPPGPQGPPGERGPEGIGKPGAAG NP_000484.2)APGQPGIPGTKGLPGAPGIAGPPGPPGFGKPGLPGLKGERGPAGLPGGPGAKGEQGPAGLPGKPGLTGPPGNMGPQGPKGIPGSHGLPGPKGETGPAGPAGYPGAKGERGSPGSDGKPGYPGKPGLDGPKGNPGLPGPKGDPGVGGPPGLPGPVGPAGAKGMPGHNGEAGPRGAPGIPGTRGPIGPPGIPGFPGSKGDPGSPGPPGPAGIATKGLNGPTGPPGPPGPRGHSGEPGLPGPPGPPGPPGQAVMPEGFIKAGQRPSLSGTPLVSANQGVTGMPVSAFTVILSKAYPAIGTPIPFDKILYNRQQHYDPRTGIFTCQIPGIYYFSYHVHVKGTHVWVGLYKNGTPVMYTYDEYTKGYLDQASGSAIIDLTENDQVWLQLPNAESNGLYSSEYVHSSFSGF LVAPM (SEQ ID NO: 1)Human COL10A1 AAATGCTGAGCTAGGGGCAGGAGGCATGGGCGGGACAGTGTTCTGmRNA Sequence CACCTTCTGCACTGCTCATCTGGGCAGAGGAAGCTTCAGAAAGCT(NCBI Reference GCCAAGGCACCATCTCCAGGAACTCCCAGCACGCAGAATCCATCT Sequence:GAGAATATGCTGCCACAAATACCCTTTTTGCTGCTAGTATCCTTG NM_000493.3)AACTTGGTTCATGGAGTGTTTTACGCTGAACGATACCAAATGCCCACAGGCATAAAAGGCCCACTACCCAACACCAAGACACAGTTCTTCATTCCCTACACCATAAAGAGTAAAGGTATAGCAGTAAGAGGAGAGCAAGGTACTCCTGGTCCACCAGGCCCTGCTGGACCTCGAGGGCACCCAGGTCCTTCTGGACCACCAGGAAAACCAGGCTACGGAAGTCCTGGACTCCAAGGAGAGCCAGGGTTGCCAGGACCACCGGGACCATCAGCTGTAGGGAAACCAGGTGTGCCAGGACTCCCAGGAAAACCAGGAGAGAGAGGACCATATGGACCAAAAGGAGATGTTGGACCAGCTGGCCTACCAGGACCCCGGGGCCCACCAGGACCACCTGGAATCCCTGGACCGGCTGGAATTTCTGTGCCAGGAAAACCTGGACAACAGGGACCCACAGGAGCCCCAGGACCCAGGGGCTTTCCTGGAGAAAAGGGTGCACCAGGAGTCCCTGGTATGAATGGACAGAAAGGGGAAATGGGATATGGTGCTCCTGGTCGTCCAGGTGAGAGGGGTCTTCCAGGCCCTCAGGGTCCCACAGGACCATCTGGCCCTCCTGGAGTGGGAAAAAGAGGTGAAAATGGGGTTCCAGGACAGCCAGGCATCAAAGGTGATAGAGGTTTTCCGGGAGAAATGGGACCAATTGGCCCACCAGGTCCCCAAGGCCCTCCTGGGGAACGAGGGCCAGAAGGCATTGGAAAGCCAGGAGCTGCTGGAGCCCCAGGCCAGCCAGGGATTCCAGGAACAAAAGGTCTCCCTGGGGCTCCAGGAATAGCTGGGCCCCCAGGGCCTCCTGGCTTTGGGAAACCAGGCTTGCCAGGCCTGAAGGGAGAAAGAGGACCTGCTGGCCTTCCTGGGGGTCCAGGTGCCAAAGGGGAACAAGGGCCAGCAGGTCTTCCTGGGAAGCCAGGTCTGACTGGACCCCCTGGGAATATGGGACCCCAAGGACCAAAAGGCATCCCGGGTAGCCATGGTCTCCCAGGCCCTAAAGGTGAGACAGGGCCAGCTGGGCCTGCAGGATACCCTGGGGCTAAGGGTGAAAGGGGTTCCCCTGGGTCAGATGGAAAACCAGGGTACCCAGGAAAACCAGGTCTCGATGGTCCTAAGGGTAACCCAGGGTTACCAGGTCCAAAAGGTGATCCTGGAGTTGGAGGACCTCCTGGTCTCCCAGGCCCTGTGGGCCCAGCAGGAGCAAAGGGAATGCCCGGACACAATGGAGAGGCTGGCCCAAGAGGTGCCCCTGGAATACCAGGTACTAGAGGCCCTATTGGGCCACCAGGCATTCCAGGATTCCCTGGGTCTAAAGGGGATCCAGGAAGTCCCGGTCCTCCTGGCCCAGCTGGCATAGCAACTAAGGGCCTCAATGGACCCACCGGGCCACCAGGGCCTCCAGGTCCAAGAGGCCACTCTGGAGAGCCTGGTCTTCCAGGGCCCCCTGGGCCTCCAGGCCCACCAGGTCAAGCAGTCATGCCTGAGGGTTTTATAAAGGCAGGCCAAAGGCCCAGTCTTTCTGGGACCCCTCTTGTTAGTGCCAACCAGGGGGTAACAGGAATGCCTGTGTCTGCTTTTACTGTTATTCTCTCCAAAGCTTACCCAGCAATAGGAACTCCCATACCATTTGATAAAATTTTGTATAACAGGCAACAGCATTATGACCCAAGGACTGGAATCTTTACTTGTCAGATACCAGGAATATACTATTTTTCATACCACGTGCATGTGAAAGGGACTCATGTTTGGGTAGGCCTGTATAAGAATGGCACCCCTGTAATGTACACCTATGATGAATACACCAAAGGCTACCTGGATCAGGCTTCAGGGAGTGCCATCATCGATCTCACAGAAAATGACCAGGTGTGGCTCCAGCTTCCCAATGCCGAGTCAAATGGCCTATACTCCTCTGAGTATGTCCACTCCTCTTTCTCAGGATTCCTAGTGGCTCCAATGTGAGTACACACAGAGCTAATCTAAATCTTGTGCTAGAAAAAGCATTCTCTAACTCTACCCCACCCTACAAAATGCATATGGAGGTAGGCTGAAAAGAATGTAATTTTTATTTTCTGAAATACAGATTTGAGCTATCAGACCAACAAACCTTCCCCCTGAAAAGTGAGCAGCAACGTAAAAACGTATGTGAAGCCTCTCTTGAATTTCTAGTTAGCAATCTTAAGGCTCTTTAAGGTTTTCTCCAATATTAAAAAATATCACCAAAGAAGTCCTGCTATGTTAAAAACAAACAACAAAAAACAAACAACAAAAAAAAAATTAAAAAAAAAAACAGAAATAGAGCTCTAAGTTATGTGAAATTTGATTTGAGAAACTCGGCATTTCCTTTTTAAAAAAGCCTGTTTCTAACTATGAATATGAGAACTTCTAGGAAACATCCAGGAGGTATCATATAACTTTGTAGAACTTAAATACTTGAATATTCAAATTTAAAAGACACTGTATCCCCTAAAATATTTCTGATGGTGCACTACTCTGAGGCCTGTATGGCCCCTTTCATCAATATCTATTCAAATATACAGGTGCATATATACTTGTTAAAGCTCTTATATAAAAAAGCCCCAAAATATTGAAGTTCATCTGAAATGCAAGGTGCTTTCATCAATGAACCTTTTCAAACTTTTCTATGATTGCAGAGAAGCTTTTTATATACCCAGCATAACTTGGAAACAGGTATCTGACCTATTCTTATTTAGTTAACACAAGTGTGATTAATTTGATTTCTTTAATTCCTTATTGAATCTTATGTGATATGATTTTCTGGATTTACAGAACATTAGCACATGTACCTTGTGCCTCCCATTCAAGTGAAGTTATAATTTACACTGAGGGTTTCAAAATTCGACTAGAAGTGGAGATATATTATTTATTTATGCACTGTACTGTATTTTTATATTGCTGTTTAAAACTTTTAAGCTGTGCCTCACTTATTAAAGCACAAAATGTTTTACCTACTCCTTATTTACGACGCAATAAAATAACATCAATAGATTTTTAGGCTGAATTAATTTGAAAGCAGCAATTTGCTGTTCTCAACCATTCTTTCAAGGCTTTTCATTGTTCAAAGTTAATAAAAAAGTAGGACAATAA AGTG (SEQ ID NO: 2)

MMP11

Extracellular matrix (ECM) is a general term for the insolublecomponents which immobilize and adhere the various cells which make upmulticellular organisms. Extracellular matrix is known to affectproliferation and differentiation of cells via cell adhesion, andincludes principally collagen, fibronectin, laminin and the like.Extracellular matrix is known to be degraded by an extracellular matrixprotease (matrix metalloproteinase or MMP, referred to below as “MMP”).MMP is an enzyme which is expressed in the course of tissue generationand differentiation via repeated cell division of a fertilized egg, andis also closely associated with invasion and metastasis of cancer.Degradation of extracellular matrix around cancer cells and in thevascular basal membrane is a necessary process for invasion andmetastasis of cancer.

MMP11 encodes matrix metalloproteinase-11. In contrast to other MMPs,which are activated extracellularly, matrix metalloproteinase-11 isactivated intracellularly by furin. MMP11 was originally identifiedthrough its overexpression in breast cancer and is thought to play animportant role in cancer progression.

Metalloproteinase-11 protein contains 488 amino acid residues. Exemplaryamino acid and nucleotide sequences from a full-length humanmetalloproteinase-11 polypeptide are shown below as SEQ ID NOs: 3 and 4.

TABLE 2 Human MAPAAWLRSAAARALLPPMLLLLLQPPPLLARALPPDAHHLHAERMetallopeptidase 11 RGPQPWHAALPSSPAPAPATQEAPRPASSLRPPRCGVPDPSDGLSPrerotein Sequence ARNRQKRFVLSGGRWEKTDLTYRILRFPWQLVQEQVRQTMAEALK(NCBI Reference VWSDVTPLTFTEVHEGRADIMIDFARYWHGDDLPFDGPGGILAHA Sequence:FFPKTHREGDVHFDYDETWTIGDDQGTDLLQVAAHEFGHVLGLQH NP_001136401.1)TTAAKALMSAFYTFRYPLSLSPDDCRGVQHLYGQPWPTVTSRTPALGPQAGIDTNEIAPLEPDAPPDACEASFDAVSTIRGELFFFKAGFVWRLRGGQLQPGYPALASRHWQGLPSPVDAAFEDAQGHIWFFQGAQYWVYDGEKPVLGPAPLTELGLVRFPVHAALVWGPEKNKIYFFRGRDYWRFHPSTRRVDSPVPRRATDWRGVPSEIDAAFQDADGYAYFLRGRLYWKFDPVKVKALEGFPRLVGPDFFGCAEPANTFL (SEQ ID NO: 3) Human MMP11AAGCCCAGCAGCCCCGGGGCGGATGGCTCCGGCCGCCTGGCTCCG mRNA SequenceCAGCGCGGCCGCGCGCGCCCTCCTGCCCCCGATGCTGCTGCTGCT (NCBI ReferenceGCTCCAGCCGCCGCCGCTGCTGGCCCGGGCTCTGCCGCCGGACGC Sequence:CCACCACCTCCATGCCGAGAGGAGGGGGCCACAGCCCTGGCATGC NM_005940.3)AGCCCTGCCCAGTAGCCCGGCACCTGCCCCTGCCACGCAGGAAGCCCCCCGGCCTGCCAGCAGCCTCAGGCCTCCCCGCTGTGGCGTGCCCGACCCATCTGATGGGCTGAGTGCCCGCAACCGACAGAAGAGGTTCGTGCTTTCTGGCGGGCGCTGGGAGAAGACGGACCTCACCTACAGGATCCTTCGGTTCCCATGGCAGTTGGTGCAGGAGCAGGTGCGGCAGACGATGGCAGAGGCCCTAAAGGTATGGAGCGATGTGACGCCACTCACCTTTACTGAGGTGCACGAGGGCCGTGCTGACATCATGATCGACTTCGCCAGGTACTGGCATGGGGACGACCTGCCGTTTGATGGGCCTGGGGGCATCCTGGCCCATGCCTTCTTCCCCAAGACTCACCGAGAAGGGGATGTCCACTTCGACTATGATGAGACCTGGACTATCGGGGATGACCAGGGCACAGACCTGCTGCAGGTGGCAGCCCATGAATTTGGCCACGTGCTGGGGCTGCAGCACACAACAGCAGCCAAGGCCCTGATGTCCGCCTTCTACACCTTTCGCTACCCACTGAGTCTCAGCCCAGATGACTGCAGGGGCGTTCAACACCTATATGGCCAGCCCTGGCCCACTGTCACCTCCAGGACCCCAGCCCTGGGCCCCCAGGCTGGGATAGACACCAATGAGATTGCACCGCTGGAGCCAGACGCCCCGCCAGATGCCTGTGAGGCCTCCTTTGACGCGGTCTCCACCATCCGAGGCGAGCTCTTTTTCTTCAAAGCGGGCTTTGTGTGGCGCCTCCGTGGGGGCCAGCTGCAGCCCGGCTACCCAGCATTGGCCTCTCGCCACTGGCAGGGACTGCCCAGCCCTGTGGACGCTGCCTTCGAGGATGCCCAGGGCCACATTTGGTTCTTCCAAGGTGCTCAGTACTGGGTGTACGACGGTGAAAAGCCAGTCCTGGGCCCCGCACCCCTCACCGAGCTGGGCCTGGTGAGGTTCCCGGTCCATGCTGCCTTGGTCTGGGGTCCCGAGAAGAACAAGATCTACTTCTTCCGAGGCAGGGACTACTGGCGTTTCCACCCCAGCACCCGGCGTGTAGACAGTCCCGTGCCCCGCAGGGCCACTGACTGGAGAGGGGTGCCCTCTGAGATCGACGCTGCCTTCCAGGATGCTGATGGCTATGCCTACTTCCTGCGCGGCCGCCTCTACTGGAAGTTTGACCCTGTGAAGGTGAAGGCTCTGGAAGGCTTCCCCCGTCTCGTGGGTCCTGACTTCTTTGGCTGTGCCGAGCCTGCCAACACTTTCCTCTGACCATGGCTTGGATGCCCTCAGGGGTGCTGACCCCTGCCAGGCCACGAATATCAGGCTAGAGACCCATGGCCATCTTTGTGGCTGTGGGCACCAGGCATGGGACTGAGCCCATGTCTCCTCAGGGGGATGGGGTGGGGTACAACCACCATGACAACTGCCGGGAGGGCCACGCAGGTCGTGGTCACCTGCCAGCGACTGTCTCAGACTGGGCAGGGAGGCTTTGGCATGACTTAAGAGGAAGGGCAGTCTTGGGCCCGCTATGCAGGTCCTGGCAAACCTGGCTGCCCTGTCTCCATCCCTGTCCCTCAGGGTAGCACCATGGCAGGACTGGGGGAACTGGAGTGTCCTTGCTGTATCCCTGTTGTGAGGTTCCTTCCAGGGGCTGGCACTGAAGCAAGGGTGCTGGGGCCCCATGGCCTTCAGCCCTGGCTGAGCAACTGGGCTGTAGGGCAGGGCCACTTCCTGAGGTCAGGTCTTGGTAGGTGCCTGCATCTGTCTGCCTTCTGGCTGACAATCCTGGAAATCTGTTCTCCAGAATCCAGGCCAAAAAGTTCACAGTCAAATGGGGAGGGGTATTCTTCATGCAGGAGACCCCAGGCCCTGGAGGCTGCAACATACCTCAATCCTGTCCCAGGCCGGATCCTCCTGAAGCCCTTTTCGCAGCACTGCTATCCTCCAAAGCCATTGTAAATGTGTGTACAGTGTGTATAAACCTTCTTCTTCTTTTTTTTTTTTTAAACTGAGGATTGTCATTAAACACA GTTGTTTTCT (SEQ ID NO: 4)

Colorectal Cancer Diagnosis

The present invention encompasses the recognition that increasedtranscription of COL10A1 and MMP11 in combination is associated with arisk or incidence of colorectal cancer. In some embodiments, the presentdisclosure provides methods of classifying an individual at risk of orsuffering from colorectal cancer. In general, such methods compriseobtaining a sample from the individual; processing the sample todetermine levels of COL10A1 and MMP11; and classifying the individual ashaving an elevated risk or incidence of colorectal cancer if the levelsof COL10A1 and MMP11 are both elevated relative to a reference.

In some embodiments, a risk of colorectal cancer comprises a risk from1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 15, 20, 25, 30, 35, 40, 45, 50, 55, 60,65, 70, 75, 80, 85, 90, 95, 100, 1000% or more relative to a reference.In some embodiments, a reference comprises an average occurrence ofcolorectal cancer in a population. In some embodiments, a referencecomprises a statistical occurrence of colorectal cancer deemed to beacceptable or unavoidable in a population by medical professionals.

In some embodiments, an individual comprises a non-human animal. In someembodiments, a non-human animal comprises a mouse. In some embodiments,a non-human animal comprises a rat. In some embodiments, a non-humananimal comprises a dog. In some embodiments, a non-human animalcomprises a non-human primate. In some embodiments, an individualcomprises a human. In some embodiments, an individual comprises a humanhaving or suspected of having colorectal cancer. In some embodiments, anindividual comprises a human having colorectal cancer in stage UICC I.In some embodiments, an individual comprises a human having colorectalcancer in stage UICC II.

In some embodiments, a sample is any sample comprising COL10A1 andMMP11. In some embodiments, a sample comprises cells from which COL10A1and MMP11 is or can be obtained. In some embodiments, a sample comprisesisolated nucleic acids. In some embodiments, a sample comprises humangenomic DNA. In some embodiments the sample is or comprises cDNA. Insome embodiments the sample is or comprises human RNA. In someembodiments the sample is or comprises human protein. In someembodiments, a sample is obtained (directly or indirectly) from aprimary colorectal tumor.

In some embodiments, the individual is classified as having an elevatedrisk or incidence of colorectal cancer if the levels of COL10A1 andMMP11 are both elevated relative to a reference. In some embodiments,the individual is classified as having an elevated risk of metastasis ifthe levels of COL10A1 and MMP11 are both elevated relative to areference.

In some embodiments, the individual is a human having colorectal cancerin stage UICC I and is classified as having an elevated risk ofprogressing to stage UICC III and/or IV if the levels of COL10A1 andMMP11 are both elevated relative to a reference. In some embodiments,the individual is a human having colorectal cancer in stage UICC II andis classified as having an elevated risk of progressing to stage UICCIII and/or IV if the levels of COL10A1 and MMP11 are both elevatedrelative to a reference.

In some embodiments, the individual is classified as having an elevatedrisk of colorectal cancer recurrence if the levels of COL10A1 and MMP11are both elevated relative to a reference. In some such embodiments, theindividual is a human having colorectal cancer in stage UICC I or UICCII.

In some of these aforementioned embodiments, COL10A1 levels areincreased 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 15, 20, 25, 30, 35, 40, 45, 50,55, 60, 65, 70, 75, 80, 85, 90, 95, 100, 1000% or more relative to areference. In some embodiments, MMP11 levels are increased 1, 2, 3, 4,5, 6, 7, 8, 9, 10, 15, 20, 25, 30, 35, 40, 45, 50, 55, 60, 65, 70, 75,80, 85, 90, 95, 100, 1000% or more relative to a reference.

In some embodiments, processing comprises processing a sample to detectlevels of COL10A1 and MMP11 cDNA or RNA. As discussed in more detailbelow, in some embodiments primers are used in quantitative reversetranscriptase PCR and microarray methods for the amplification anddetection of COL10A1 and MMP11 or fragments thereof. Methods ofquantifying levels of mRNA transcripts are well known in the art andinclude but are not limited to northern analysis, semi-quantitativereverse transcriptase PCR, quantitative reverse transcriptase PCR, andmicroarray analysis. These and other basic RNA transcript detectionprocedures are described in Ausebel et al. (Ausubel F M, Brent R,Kingston R E, Moore D D, Seidman J G, Smith J A, Struhl K (eds). 1998.Current Protocols in Molecular Biology. Wiley: New York).

In some embodiments, the disclosed methods may involve some level of RNApreparation. Indeed, the template for an amplification reaction (e.g., aPCR reaction) is typically DNA and the target material to be analyzed istypically expressed RNA from human cells or tissue. As a result, thestarting template material for the amplification reaction will often becDNA which was generated from purified RNA. The RNA preparation step maybe performed far removed from the actual amplification step, forexample, in another laboratory, or at a much earlier time; however, insome embodiments the RNA isolation and preparation of the cDNA may occurin conjunction with the amplification step of the methods.

When an RNA preparation step is included in the disclosed methods, themethod of RNA preparation can be any method of RNA preparation thatproduces enzymatically manipulatable mRNA. For example, the RNA can beisolated by using the guanidinium isothiocyanate-ultracentrifugationmethod, the guanidinium and phenol-chloroform method, the lithiumchloride-SDS-urea method or poly A+/mRNA from tissue lysates usingoligo(dT) cellulose method, e.g., see Chomczynski and Sacchi, Anal.Biochem. 162:156 (1987); and Auffray and Rougeon, Eur. J. Biochem.107:303-314 (1980).

In some embodiments, disclosed methods involve cDNA preparation. ThecDNA preparation step may be performed far removed from the actualamplification step, for example, in another laboratory, or at a muchearlier time; however, in some embodiments the preparation of the cDNAmay occur in conjunction with the amplification step of the methods.

When a cDNA preparation step is included in the disclosed methods, themethod of cDNA preparation can be any method of cDNA preparation thatproduces enzymatically manipulatable cDNA. For example, the cDNA can beprepared by using, for example, random primers, poly-d(T) oligos, orNVd(T) oligos. For the purpose of data normalization, an equal amount oftotal RNA is typically used for cDNA synthesis. Many examples exist ofperforming reverse transcription to produce cDNA for use in PCR,including the following: Glisin et al., Biochemistry 13:2633-7 (1974);and Chirgwin et al., Biochemistry 18:5294-9 (1979).

Reverse transcriptases from any source (native or recombinant) may beused in the practice of the present disclosure. Suitable reversetranscriptases include, but are not limited to, those from Moloneymurine leukemia virus (M-MLV), human T-cell leukemia virus type I(HTLV-I), bovine leukemia virus (BLV), Avian Sarcoma Leukemia Viruses(ASLV) including Rous Sarcoma Virus (RSV) and Avian Myeloblastosis Virus(AMV), human immunodeficiency virus (HIV), cauliflower mosaic virus,Saccharomyces, Neurospora, Drosophila, primates, and rodents.

The use of oligonucleotide sequences as primers to amplify COL10A1 andMMP11 in a sample is not limited to any particular nucleic acidamplification technique or any particular modification thereof. In fact,oligonucleotide sequences can be employed in any of a variety of nucleicacid amplification methods well-known in the art (see, for example,Kimmel and Berger, Methods Enzymol. 152: 307-316 (1987); Sambrook etal., “Molecular Cloning: A Laboratory Manual”, 1989, 2^(nd) Ed., ColdSpring Harbour Laboratory Press: New York, N.Y.; “Short Protocols inMolecular Biology”, Ausubel (Ed.), 2002, 5^(th) Ed., John Wiley & Sons:Secaucus, N.J.).

Nucleic acid amplification methods are well known in the art andinclude, but are not limited to, the Polymerase Chain Reaction (or PCR,described, for example, in U.S. Pat. Nos. 4,683,195, 4,683,202 and4,889,818, each of which is incorporated herein by reference in itsentirety). In its simplest form, PCR is an in vitro method for theenzymatic synthesis of specific DNA sequences, using two primers thathybridize to opposite strands and flank the region of interest in thetarget DNA. A plurality of reaction cycles, each cycle comprising: adenaturation step, an annealing step, and a polymerization step, resultsin the exponential accumulation of a specific DNA fragment. The terminiof the amplified fragments are defined as the 5′ ends of the primers.Examples of DNA polymerases capable of producing amplification productsin PCR reactions include, but are not limited to: E. coli DNA polymeraseI, Klenow fragment of DNA polymerase I, T4 DNA polymerase, thermostableDNA polymerases isolated from Thermus aquaticus (Taq) which areavailable from a variety of sources (for example, Perkin Elmer), Thermusthermophilus (United States Biochemicals), Bacillus stereothermophilus(Bio-Rad), or Thermococcus litoralis (“Vent” polymerase, New EnglandBiolabs).

In some embodiments, the PCR reaction is a “kinetic PCR” (kPCR) or“kinetic RT-PCR” (kRT-PCR) reaction, which are also referred to as“real-time PCR” and “real-time RT-PCR,” respectively. These methodsinvolve detecting PCR products via a probe that provides a signal(typically a fluorescent signal) that is related to the amount ofamplified product in the sample. Examples of commonly used probes usedin kPCR and kRT-PCR include the following probes: TAQMAN® probes,Molecular Beacons probes, SCORPION® probes, and SYBR® Green probes.Briefly, TAQMAN® probes, Molecular Beacons, and SCORPION® probes eachhave a fluorescent reporter dye (also called a “fluor”) attached on oraround the 5′ end of the probes and a quencher moiety attached on oraround the 3′ end of the probes. In the unhybridized state, theproximity of the fluor and the quench molecules prevents the detectionof fluorescent signal from the probe. During PCR, when the polymerasereplicates a template on which a probe is bound, the 5′-nucleaseactivity of the polymerase cleaves the probe at a site between the fluorand quencher thus, increasing fluorescence with each replication cycle.SYBR® Green probes bind double-stranded DNA and upon excitation emitlight; thus as PCR product accumulates, fluorescence increases.

In some embodiments, the PCR reaction is used in a “single-plex” PCRassay. “Single-plex” refers to a single assay that is not carried outsimultaneously with any other assays. Single-plex assays includeindividual assays that are carried out sequentially.

In some embodiments, the PCR reaction is used in a “multiplex” PCRassay. The term “multiplex” refers to multiple assays that are carriedout simultaneously, in which detection and analysis steps are generallyperformed in parallel. Within the context of the present disclosure, amultiplex assay will include the use of the primers, alone or incombination with additional primers to identify, for example, COL10A1and MMP11 simultaneously.

In some embodiments, the level of amplification product is assessed bymicroarray analysis.

In some embodiments, a first amplification step amplifies a region of atarget gene. In some embodiments the amplification product is less thanabout 3000, 2900, 2800, 2700, 2600, 2500, 2400, 2300, 2200, 2100, 2000,1900, 1800, 1700, 1600, 1500, 1400, 1300, 1200, 1100, 1000, 900, 800,700, 600, 500, 400, 300, 250, 225, 200, 175, 150, 100, or 50 nucleotideslong.

Colorectal Cancer Treatment

The present invention encompasses the recognition that individualshaving an increased risk or incidence of colorectal cancer, asdetermined by elevated levels of COL10A1 and MMP11 in combination, canbe treated with an agent for treating incidence and/or risk ofcolorectal cancer. In general, such methods comprise administering tothe individual a therapeutically effective amount of an agent fortreating incidence and/or risk of colorectal cancer, wherein a samplefrom the individual has previously been determined to contain anelevated level of both COL10A1 and MMP11 relative to a reference. Insome embodiments, levels of COL10A1 and MMP11 are determined accordingto the methods described herein.

The present invention also encompasses the recognition that individualshaving an increased risk of metastasis, as determined by elevated levelsof COL10A1 and MMP11 in combination, may benefit from a different typeof treatment than individuals with a reduced risk of metastasis. Inparticular, an individual with an increased risk of metastasis mightreceive a more aggressive type of treatment than an individual with areduced risk of metastasis. Alternatively or additionally, an individualwith an increased risk of metastasis might receive a treatment that isdesigned to reduce the likelihood of metastasis. In general, suchmethods comprise administering to the individual a therapeuticallyeffective amount of an agent for treating incidence and/or risk ofcolorectal cancer and/or metastasis, wherein a sample from theindividual has previously been determined to contain an elevated levelof both COL10A1 and MMP11 relative to a reference. In some embodiments,levels of COL10A1 and MMP11 are determined according to the methodsdescribed herein.

In some embodiments, an agent for treating incidence and/or risk ofcolorectal cancer is or comprises RNA. In some embodiments, an agent isor comprises siRNA. In some embodiments, an agent is or comprises shRNA.In some embodiments, an agent is or comprises protein. In someembodiments, an agent is or comprises an antibody. In some embodiments,an agent is or comprises a chemical. In some embodiments, an agent is orcomprises a chemotherapeutic agent. Examples of known chemotherapeuticagents include, but are not limited to, adriamycin, dexamethasone,vincristine, cyclophosphamide, fluorouracil, topotecan, taxol,interferons, platinum derivatives, taxane (e.g., paclitaxel), vincaalkaloids (e.g., vinblastine), anthracyclines (e.g., doxorubicin),epipodophyllotoxins (e.g., etoposide), cisplatin, an mTOR inhibitor(e.g., a rapamycin), methotrexate, actinomycin D, dolastatin 10,colchicine, emetine, trimetrexate, metoprine, cyclosporine,daunorubicin, teniposide, amphotericin, alkylating agents (e.g.,chlorambucil), 5-fluorouracil, campthothecin, cisplatin, metronidazole,and Gleevec™, among others.

In accordance with the methods of the invention, an agent can beadministered to a subject alone, or as a component of a composition ormedicament (e.g., in the manufacture of a medicament for the preventionor treatment of colorectal cancer), as described herein. Thecompositions can be formulated with a physiologically acceptable carrieror excipient to prepare a pharmaceutical composition. The carrier andcomposition can be sterile. The formulation should suit the mode ofadministration. Methods of formulating compositions are known in the art(see, e.g., Remington's Pharmaceuticals Sciences, 17^(th) Edition, MackPublishing Co., (Alfonso R. Gennaro, editor) (2005)). Suitablepharmaceutically acceptable carriers are known in the art.

The composition or medicament, if desired, can also contain minoramounts of wetting or emulsifying agents, or pH buffering agents. Thecomposition can be a liquid solution, suspension, emulsion, tablet,pill, capsule, sustained release formulation, or powder. The compositioncan also be formulated as a suppository, with traditional binders andcarriers such as triglycerides. Oral formulations can include standardcarriers such as pharmaceutical grades of mannitol, lactose, starch,magnesium stearate, polyvinyl pyrollidone, sodium saccharine, cellulose,magnesium carbonate, etc.

An agent described herein (or a composition or medicament containing anagent described herein) is administered by any appropriate route. Insome embodiments, an agent is administered subcutaneously. As usedherein, the term “subcutaneous tissue”, is defined as a layer of loose,irregular connective tissue immediately beneath the skin. For example,the subcutaneous administration may be performed by injecting acomposition into areas including, but not limited to, thigh region,abdominal region, gluteal region, or scapular region. In someembodiments, an agent is administered intravenously. In someembodiments, an agent is administered orally. In other embodiments, anagent is administered by direct administration to a target tissue, suchas heart or muscle (e.g., intramuscular), tumor (intratumorallly),nervous system (e.g., direct injection into the brain;intraventricularly; intrathecally). Alternatively, an agent (or acomposition or medicament containing an agent) can be administered byinhalation, parenterally, intradermally, transdermally, ortransmucosally (e.g., orally or nasally). More than one route can beused concurrently, if desired.

In various embodiments, an agent is administered at a therapeuticallyeffective amount. As used herein, the term “therapeutically effectiveamount” is largely determined based on the total amount of thetherapeutic agent contained in the pharmaceutical compositions of thepresent invention. Generally, a therapeutically effective amount issufficient to achieve a meaningful benefit to the subject (e.g.,treating the underlying disease or condition). In some particularembodiments, appropriate doses or amounts to be administered may beextrapolated from dose-response curves derived from in vitro or animalmodel test systems.

In some embodiments, a composition is administered in a therapeuticallyeffective amount and/or according to a dosing regimen that is correlatedwith a particular desired outcome (e.g., with treating or reducing riskfor colorectal cancer).

Particular doses or amounts to be administered in accordance with thepresent invention may vary, for example, depending on the nature and/orextent of the desired outcome, on particulars of route and/or timing ofadministration, and/or on one or more characteristics (e.g., weight,age, personal history, genetic characteristic, lifestyle parameter, orcombinations thereof).

In some embodiments, a provided composition is provided as apharmaceutical formulation. In some embodiments, a pharmaceuticalformulation is or comprises a unit dose amount for administration inaccordance with a dosing regimen correlated with achievement of thereduced incidence or risk of colorectal cancer.

In some embodiments, a formulation comprising an agent described hereinis administered as a single dose. In some embodiments, a formulationcomprising an agent described herein is administered at regularintervals. Administration at an “interval,” as used herein, indicatesthat the therapeutically effective amount is administered periodically(as distinguished from a one-time dose).

In some embodiments, a formulation comprising an agent described hereinis administered at regular intervals indefinitely. In some embodiments,a formulation comprising an agent described herein is administered atregular intervals for a defined period.

Kits

In some embodiments, the present disclosure provides kits comprisingmaterials useful for the amplification and detection of COL10A1 andMMP11. The inventive kits may be used by diagnostic laboratories,experimental laboratories, or practitioners.

Materials and reagents useful for the amplification and detection ofCOL10A1 and MMP11 according to the present disclosure may be assembledtogether in a kit. In some embodiments, an inventive kit comprises atleast one primer set for each of COL10A1 and MMP11, and optionally,amplification reaction reagents. In some embodiments, the kit comprisesnucleic acid detection probes.

Suitable amplification reaction reagents that can be included in aninventive kit include, for example, one or more of: buffers; enzymeshaving polymerase activity; enzyme cofactors such as magnesium ormanganese; salts; nicotinamide adenide dinuclease (NAD); anddeoxynucleoside triphosphates (dNTPs) such as, for example,deoxyadenosine triphospate; deoxyguanosine triphosphate, deoxycytidinetriphosphate and deoxythymidine triphosphate, biotinylated dNTPs,suitable for carrying out the amplification reactions.

Depending on the procedure, the kit may further comprise one or more of:wash buffers and/or reagents, hybridization buffers and/or reagents,labeling buffers and/or reagents, and detection means. The buffersand/or reagents included in a kit are preferably optimized for theparticular amplification/detection technique for which the kit isintended. Protocols for using these buffers and reagents for performingdifferent steps of the procedure may also be included in the kit.

In some embodiments, the kit comprises a positive control. In someembodiments, a positive control comprises COL10A1 and/or MMP11 cDNA. Insome embodiments, a kit comprises a negative control. In someembodiments, a negative control comprises any sequence not subject toamplification by primers useful for the amplification and detection ofCOL10A1 and MMP11. Furthermore, the kits may be provided with aninternal control as a check on the amplification procedure and toprevent occurrence of false negative test results due to failures in theamplification procedure. An optimal internal control sequence isselected in such a way that it will not compete with the target nucleicacid sequence in the amplification reaction (as described above).

Kits may also contain reagents for the isolation of nucleic acids frombiological specimen prior to amplification.

The reagents may be supplied in a solid (e.g., lyophilized) or liquidform. The kits of the present disclosure optionally comprise differentcontainers (e.g., vial, ampoule, test tube, flask or bottle) for eachindividual buffer and/or reagent. Each component will generally besuitable as aliquoted in its respective container or provided in aconcentrated form. Other containers suitable for conducting certainsteps of the amplification/detection assay may also be provided. Theindividual containers of the kit are preferably maintained in closeconfinement for commercial sale.

The kit may also comprise instructions for using the amplificationreaction reagents, primer sets, and/or primer/probe sets according tothe present disclosure. Instructions for using the kit according to oneor more methods of the present disclosure may comprise instructions forprocessing the biological sample, extracting nucleic acid molecules,and/or performing the test; instructions for interpreting the results aswell as a notice in the form prescribed by a governmental agency (e.g.,FDA) regulating the manufacture, use or sale of pharmaceuticals orbiological products.

Computer Systems

Methods described herein can be implemented in a computer system havinga processor that executes specific instructions in a computer program.In some embodiments, the computer system may be arranged to output anindividual's colorectal cancer classification based on receiving anindividual's level of COL10A1 and MMP11. In some embodiments, acolorectal cancer classification comprises a colorectal cancer stage. Insome embodiments, a colorectal cancer classification comprisesmetastatic or non-metastatic. In some embodiments, a colorectal cancerclassification comprises a risk of developing colorecatal cancer. Insome embodiments, the computer system may be arranged to output amedication profile based on receiving an individual's level of COL10A1and MMP11. Particularly, the computer program may include instructionsfor the system to select the most appropriate medication (e.g., achemotherapeutic drug) for an individual.

In some embodiments, the computer program may be configured such thatthe computer system can identify the individual's cancer classificationbased on received data and provide a preliminary identification of theuniverse of possible medications. The system may be able to rank-orderthe identified medications based on specific co-factors in thealgorithmic equation. The system may be able to adjust the rank orderingbased on the levels of COL10A1 and MMP11 in the individual. The systemmay be able to adjust the rank ordering based on clinical responserelating to the individual (or of a family member of the individual whohas or is suspected of having colorectal cancer).

FIG. 6 is a block diagram of a computer system 600 that can be used inthe operations described above, according to one embodiment. The system600 includes a processor 610, a memory 620, a storage device 630 and aninput/output device 640. Each of the components 610, 620, 630 and 640are interconnected using a system bus 650. The system may includeanalyzing equipment 660 for determining the individual's levels ofCOL10A1 and MMP11.

The processor 610 is capable of processing instructions for executionwithin the system 600. In one embodiment, the processor 610 is asingle-threaded processor. In another embodiment, the processor 610 is amulti-threaded processor. The processor 610 is capable of processinginstructions stored in the memory 620 or on the storage device 630,including for receiving or sending information through the input/outputdevice 640.

The memory 620 stores information within the system 600. In oneembodiment, the memory 620 is a computer-readable medium. In oneembodiment, the memory 620 is a volatile memory unit. In anotherembodiment, the memory 620 is a non-volatile memory unit.

The storage device 630 is capable of providing mass storage for thesystem 600. In one embodiment, the storage device 630 is acomputer-readable medium. In various different embodiments, the storagedevice 630 may be a floppy disk device, a hard disk device, an opticaldisk device, or a tape device.

The input/output device 640 provides input/output operations for thesystem 600. In one embodiment, the input/output device 640 includes akeyboard and/or pointing device. In one embodiment, the input/outputdevice 640 includes a display unit for displaying graphical userinterfaces.

The system 600 can be used to build a database. FIG. 7 shows a flowchart of a method 700 for building a database for use in determining acolorectal cancer classification and/or selecting a medication for anindividual. Preferably, the method 700 is performed in the system 600.For example, a computer program product can include instructions thatcause the processor 610 to perform the steps of the method 700. Themethod 700 includes the following steps.

Receiving, in step 710, an individual's levels of COL10A1 and MMP11. Acomputer program in the system 600 may include instructions forpresenting a suitable graphical user interface on input/output device640, and the graphical user interface may prompt the user to enter thelevels 670 using the input/output device 640, such as a keyboard.

Receiving, in step 720, a plurality of medication profiles or colorectalcancer classification profiles 680. The profiles 680 are specified basedon the levels 670. The user may enter the profiles 680 using theinput/output device 640, such as a keyboard. For example, the profile680 may include information 690 regarding at least one medication orcolorectal cancer classification.

Storing, in step 730, the received levels 670 and the profiles 680 suchthat each profile 680 is associated with a set of levels 670. The system600 may store the profiles 680 and the levels 670 in the storage device630. For example, when the storing is complete, the system 600 canidentity a particular one of the profiles 680 that is associated withspecific levels 670. Having identified the profile 680, the system 600can access the information 690 contained within the identified profile680, as will be described in the following example.

The system 600 may be used for selecting a medication or colorectalcancer classification. FIG. 8 shows a flow chart of a method 800 ofselecting a medication or colorectal cancer classification for anindividual. Preferably, the method 800 is performed in the system 600.For example, a computer program product can include instructions thatcause the processor 610 to perform the steps of the method 800. Themethod 800 includes the following steps.

Receiving, in step 810, an individual's levels of COL10A1 and MMP11. Thelevels may be entered by a user via input/output device 640. Forexample, the user may obtain the individual's levels of COL10A1 andMMP11 using the analyzing equipment 660 (which may or may not beconnected to the system 600). The user may type the individual's levelson input/output device 640, such as a keyboard, for receipt by thesystem 600.

The levels may also be received directly from the analyzing equipment660. For example, analyzing equipment 660 may include a processor andsuitable software such that it can communicate over a network. Thesystem 600 may be connected to the analyzing equipment 660 throughinput/output device 640, such as a network adapter, and directly receivethe individual's levels of COL10A1 and MMP11.

Identifying, in step 820, one of the profiles 680 that is associatedwith the individual's levels of COL10A1 and MMP11. For example, thesystem 600 may perform a database search in the storage device 630.Particularly, the system 600 may access the levels 670 for individualprofiles 680 until a match is found. Optional step 825 will be describedbelow.

Outputting, in step 830, the identified profile 680 in response toreceiving the individual's levels of COL10A1 and MMP11. The system mayoutput the identified profile 680 through input/output device 640. Forexample, the identified profile may be printed or displayed in asuitable graphical user interface on a display device. As anotherexample, the system 600 may transmit the identified profile over anetwork, such as a local area network or the Internet, to which theinput/output device 640 is connected.

The profiles 680 can be created such that there is flexibility in howthe system 600 outputs them. For example, the information 690 in one ormore of the profiles 680 may include a ranking of several medications orcolorectal cancer classifications. The program may include instructionsfor applying rules to the received individual's levels and adjust theranking accordingly. In such implementations, the method 800 may includeoptional step 825 of adjusting the ranking before outputting theidentified profile. For example, the system 600 may receive a level ofan additional gene correlated with colorectal cancer incidence and/orrisk (e.g., ABHD2) and adjust the ranking accordingly in step 825. Asanother example, step 825 may involve adjusting the ranking based on aclinical response. The clinical response may be received by the system600 in the same way as the individual's levels. For example, the rankingcan be adjusted based on a clinical response by the individual or amember of the individual's family.

The profiles 680 may be updated as necessary. For example, theintroduction of a new medication on the market or new information aboutcolorectal cancer may prompt a revision of one or more existingprofiles. A new medication may also be the basis for creating a newmedication profile. The adjustment or creation of profiles may be donesubstantially as described above.

The profiles 680 may be used for medication selection and/or colorectalcancer classification in the same system where they were created, or ina different system. That is, the system 600 may first be used forbuilding a database of the profiles 680, and the system 600 maythereafter be used to select a profile for the levels of a specificindividual. As another example, one or more profiles 680 may betransmitted within a computer readable medium such as a global computernetwork for remote processing according to the invention.

EXAMPLES Example 1: COL10A1 and MMP11 Expression in Colorectal CarcinomaPrimary Tumors is Associated with Metastatic Disease

Although the UICC staging is an established histopathologicalcategorization system for colorectal carcinomas (CRC) various prognosticsubgroups exist within the stages. To guarantee adequate treatmentmolecular markers maybe helpful to select high or low risk cases duringclinical routine. Robust expression and valid identification inroutinely asservated material is indispensable as such classifiers.

Patients and Methods

During microarray comparison (Affymetrix, HG-U133A) of 80 fresh frozenCRC samples (stage UICC I, II: n=40 vs. stage UICC III: n=40) 23 genesrelated to metastases have been identified. Five selected markers(ABDH2, COL10A1, MMP-11, C8orf30A, SLC35D1) were validated by RT-PCRretrospectively (stage UICC I-IV: n=82) and prospectively (stage UICCI-IV: n=155) after RNA isolation by a high throughput platform fromroutinely harvested FFPE CRC tissues. The marker correlation in thetumor specimens and the correlation of RT-PCR results withimmunohistochemistry were compared. The prognostic power was evaluatedby multiparametric tests (Bagging, SVM, LDA, Ord.Log.Reg.)

Results

ABDH2, COL10A1, MMP-11, C8orf30A and SLC35D1 were significantlydifferent expressed in stage UICC I, II vs. III by microarray analysis(p<0.001). Retrospective and prospective RT-PCR validation in FFPEtissue showed that expression of COL10A1 (p=0.001), MMP11 (p=0.006), andABHD2 (p=0.01) were robustly expressed and significantly associated withmetastasis (stage UICC III/IV). Correlation was strongest betweenCOL10A1 and MMP11 with a Spearman's rho value of 0.6-0.82. RT-PCRresults did not correlate with immunohistochemistry but follow up instage UICC II CRC indicated a relation to tumor recurrence.Multiparametric tests identified AUC values between 0.754 (Bagged trees)and 0.795 (SVM).

Conclusion

COL10A1 and MMP11 show a robust and stage dependent expression in CRCprimary tumors which is correlated to metastases. They may indicatetumor recurrence after treatment and could therefore act as prognosticprofilers to select high risk cases in the future.

Example 2: COL10A1 and MMP11 Expression in Colorectal Carcinoma PrimaryTumors Indicates Metastatic Disease

The goals of the study were to determine molecular markers which may beused in the primary tumor in order to predict metastatic disease. Thesemarkers may be used to detect patients in stage UICC II with high riskfor recurrent tumor development after primary therapy and to evaluatethe predictive force of single molecular markers against complexmultiparameter analysis.

Extraction of Markers Indicating Metastatic Colorectal Carcinoma fromComparative Transcriptome Analyses

Microarray analyses were performed with specimen from primary tumorresections of 80 previously untreated patients with colorectal carcinoma(CRC) (Table 3). Of these patients 40 suffered from tumors innon-metastatic stages UICC I and UICC II and 40 from tumors in themetastatic stage UICC III, respectively. By multivariant biostatisticalanalyses of the results including the gene expression values amulti-gene panel was extracted, which showed a significant associationwith the metastatic disease, as reported recently (Croner et al, AnnSurg. 2008; Croner et al., Cancer 2005). From this gene panel threerobustly expressed markers were selected for the present study (ABHD2,C8orf30A, SLC35D1). ABHD2 (FIG. 1A) and C8orf30A (FIG. 1D) exhibitincreased expression levels in metastatic stages, whereas the expressionof SLC35D1 (FIG. 1E) was decreased. The expression level of all threemarkers was highly significantly different in primary tumors of patientswith metastatic as compared to non-metastatic disease (FIGS. 1A, D, E).In addition, two further genes were selected by manually rescreening ofthe microarray results. The selection criteria for these two genes werethat they were not identified during multivariate statistics in thepreviously determined multi-gene panel, but were highly significantlyover-expressed in metastatic stages during single value calculations andshowed highest expression profiles. The latter criterion was used inorder to support an easy detection of these markers in subsequentclinical routine approaches of tumor stage diagnostics. The two bestfitting genes to these criteria encoded the collagen variant COL10A1 andthe matrix-metalloproteinase 11 (MMP-11). Both genes were in themicroarray analysis highly significantly associated with the metastatictumour stage UICC III (FIGS. 1 B, C), but exhibited a clearly higherexpression level as compared to the other three markers (FIG. 1, compareB, C vs. A, D, E). In receiver operating characteristic (ROC) analysesarea under curve (AUC) values between 0.814 and 0.723 were obtained forthe five markers (FIG. 1A-E, right panels). Correlation analyses usingscatterplot matrices revealed the strongest correlation between COL10A1and MMP11 with a Spearman's rho value of 0.82 (FIG. 1F). The correlationof the expression between the other markers was only low or negligible.

TABLE 3 Validation Cohort Microarrays Pilot Study (Polyprobe) n 80 82155 Gender (male:female) 50:30 42:40 87:68 Age median (range) 66 (47-86)67 (37-92) 69 (24-91) Histologic type Adenocarcinoma 80 70 145 Mucinousadenocarcinoma 0 12 10 pT pT1 6 7 16 pT2 19 14 33 pT3a (≤1 mm) 14 8 28pT3b (>1-≤5 mm) 13 12 26 pT3c (>5-15 mm) 9 14 14 pT3d (>15 mm) 1 4 15pT3 nos 2 1 0 pT4a 4 16 17 pT4b 8 6 2 pT4c 0 0 3 pT4 nos 4 0 0 pTx 0 0 1pN pN0 40 44 91 pN1a 29 13 18 pN1b 11 11 18 pN2a 0 6 11 pN2b 0 8 17Distant metastases MO 0 61 122 M1a 0 13 19 M1b 0 8 14 Stage (UICC 7^(th)ed) IA 6 7 15 IB 11 10 27 IIA 19 20 39 IIB 4 2 3 IIC 0 2 2 IIIA 14 2 5IIIB 20 12 24 IIIC 6 6 7 IVA 0 13 19 IVB 0 8 14 Lymph invasion L0 53 4998 L1 27 33 57 Venous invasion V0 80 77 145 V1 0 5 10 Grading Low grade(G1, 2) 65 45 115 High grade (G3, 4) 15 37 40 R classification R0 80 66154 R1 0 1 1 R2 0 14 0 RX 0 1 0 Tumor site Coecum 8 14 21 Ascendingcolon 8 17 21 Hepatic flexure 3 9 7 Transverse colon 2 4 18 Splenicflexure 1 2 2 Descending colon 4 7 6 Sigmoid colon 20 29 37 Rectum 34 43nos: not otherwise specified

Retrospective Validation of Metastasis Markers Using RNA from RoutinelyProcessed Clinical Specimen

In order to validate the five selected markers with a clinicallyrelevant and easily applicable methodology, a retrospective pilot studywas carried out including primary CRC tissues from 82 patients indifferent stages [UICC I (n=17), UICC II (n=24), UICC III (n=20), UICCIV (n=21), Table 3]. An automated extraction method for RNA from FFPEtissue sections and subsequent quantitative RT-PCR were used todetermine expression of these marker genes. With this approach, COL10A1(p=0.001), MMP11 (p=0.006), and ABHD2 (p=0.01) were found to bestatistically significantly associated with the metastatic tumor stages(Fig. A-C, left). AUC values of these three markers were between 0.665and 0.718. The stage related expression of C8orf30A and SLC35D1 couldnot be confirmed (FIG. 2 D, E). Of note, the expression of C8orf30A andSLC35D1 was clearly lower as the expression of the three other markers(FIG. 2, compare A-C and D, E). As already identified in the microarrayanalysis the correlation of expression was highest between COL10A1 andMMP11 (FIG. 2F, Spearman's rho=0.60)

Prospective Validation Study of Metastasis Markers Using RoutinelyProcessed Clinical Specimens

In order to unequivocally validate the stage-related expression of thefive marker genes a prospective study was carried out including 155patients with different stages of colorectal carcinoma [UICC I (n=42),UICC II (n=44), UICC III (n=36), UICC IV (n=33)]. As above, theexpression of the marker genes was analyzed with RT-PCR using RNA fromFPPE-extracted tumor RNA. In this study, the markers ABDH2, COL10A1 andMMP11 could be confirmed to be highly significantly associated with themetastatic stages of colorectal carcinoma (FIG. 3 A-C). Again theexpression levels of these three genes were higher as compared toC8orf30A and SLC35D1 (FIG. 3, compare A-C vs. D, E). ROC analysesindicated that specificity and sensitivity were highest for COL10A1(AUC=0.766; FIG. 3B, right) and MMP11 (AUC=0.748; FIG. 3C, left),respectively. Correlation analysis confirmed the close relation of thesetwo markers (FIG. 3F, Spearman's rho=0.73). Moreover, a weak correlationof ABHD2 and COL10A1 was noticed (FIG. 3F, Spearman's rho=0.50).

COL10A1 and MMP11 Indicate Increased Risk of Disease Recurrence in UICCII Stage Patients

From these results, COL10A1 and MMP11 were identified as being the bestmarkers in order to predict metastasis via gene expression in CRCprimary tumors. Graphical display of the expression levels of the twogenes in all of the different tumors from FFPE tissue of the prospectivevalidation study demonstrated that high expression is preferentiallyassociated with metastatic stages (FIG. 4A, B) and low expression withnon-metastatic (FIG. 4A, B) stages of CRC.

However, this graphical display also showed that some tumors withputatively non-metastatic stage UICC II showed high expression of thesegenes (FIG. 4A, B; asterisks). This may indicate increased risk of tumorrecurrence of the disease in these cases (FIG. 4A, B). Due to the factthat follow up time of the prospective validation study was too short toidentify recurrent tumors, this hypothesis was analyzed using the UICCII stage patients from the microarray cohort. Of note, most of thosepatients with tumor recurrence showed originally a high expression levelof either COL10A1 or MMP11 in the primary tumor (FIG. 4C). Finallywhether different multiparametric tests (Bagging, SVM, LDA,Ord.Log.Reg.) including all of the five markers may confirm thepredictive power of these markers was investigated. In these analyses,AUC values between 0.754 (Bagged trees) and 0.795 (SVM) were determined(FIG. 4D). These analyses confirmed with an unbiased statistical teststhe great values of the selected marker panel.

Predictive Force of COL10A1 and MMP11 is Selectively Exhibited at theRNA Level

The gene products of COL10A1 and MMP11 are both secreted proteins.Accordingly protein levels may vary in different tumors in a not tumorstages related manner due to different secretion modalities andintratumoral deposition of the proteins. Accordingly, the detection ofthe respective proteins may not be related to the tumor stage ascompared to RNA. In order to investigate this, twelve CRC specimens wereselected which exhibited either high (n=6) or a low (n=6) expression ofCOL10A1 (Table 4, low expression COL10A1 P1-P6; high expression P7-P12).As expected the expression of MMP11 RNA correlated well with the COL10A1RNA (Table 4). Immunohistochemical detection of both proteins on serialsections showed that both proteins were present in higher amounts in thetumor tissues (FIG. 5A, panels A, B, D, and E, and FIG. 5B, panels G, H,J, and K) as compared to the normal colon tissues of the same patients(FIG. 5A, panels C and F). However, proteins levels of both markers wereneither related to the RNA level (Table 4) nor with each other (FIG. 5A,compare panels A, B and D, E; Table 4). These findings demonstrated thatthe two markers are validly associated with metastatic disease at theRNA level only, but not at the protein level.

TABLE 4 qRT-PCR Immunohistochemistry Staining Patient ID (40-ΔCT) (cellcount/intensity) COL10A1 P1 29.05 3/+++ P2 31.07 — P3 31.48 — P4 32.75 —P5 32.77 1/+ P6 32.94 — P7 35.14 — P8 35.19 1/+ P9 35.31 2/++ P10 35.371/++ P11 35.71 1/+ P12 36.24 1/++ MMP11 P1 24.08 3/+++ P2 29.93 2/++ P331.08 3/+++ P9 31.99 2/+ P8 33.38 2/++ P11 34.72 3/+++ P4 35.43 2/+++ P636 2/++ P5 36.02 3/+++ P7 36.26 3/+++ P10 36.53 3/+ P12 37.03 2/+

EQUIVALENTS

Those skilled in the art will recognize, or be able to ascertain usingno more than routine experimentation, many equivalents to the specificembodiments of the invention described herein. The scope of the presentinvention is not intended to be limited to the above Description, butrather is as set forth in the following claims:

What is claimed is:
 1. A method of treating an individual at risk of orsuffering from colorectal cancer, the method comprising administering tothe individual a therapeutically effective amount of a chemotherapeuticagent for treating colorectal cancer, wherein, prior to administration,a sample from the individual has been determined to have: (i) a level ofRNA transcribed from the COL10A1 gene that is increased at least 10%relative to a level of RNA transcribed from the COL10A1 gene in areference sample, and a level of RNA transcribed from the ABHD2 genethat is increased at least 10% relative to a level of RNA transcribedfrom the ABHD2 gene in a reference sample; or (ii) a level of RNAtranscribed from the MMP11 gene that is increased at least 10% relativeto a level of RNA transcribed from the MMP11 gene in a reference sample,and a level of RNA transcribed from the ABHD2 gene that is increased atleast 10% relative to a level of RNA transcribed from the ABHD2 gene ina reference sample.
 2. The method of claim 1, wherein the individual issuffering from colorectal cancer in stage UICC I or stage UICC II. 3.The method of claim 2, wherein the individual is at risk of progressingto stage UICC III or stage UICC IV of colorectal cancer.
 4. The methodof claim 1, wherein the sample comprises a tumor tissue.
 5. The methodof claim 4, wherein the tumor tissue is from a primary colorectal tumor.6. The method of claim 1, wherein the colorectal cancer is metastatic.7. The method of claim 1, wherein the colorectal cancer is a recurrentcancer.
 8. The method of claim 1, further comprising determining thelevel of RNA transcribed from the ABHD2 gene in the sample, anddetermining the level of RNA transcribed from the COL10A1 gene and/orthe MMP11 gene in the sample.
 9. The method of claim 1, wherein theindividual is a human.
 10. The method of claim 1, wherein the referencesample is a historical sample from the individual.
 11. The method ofclaim 1, wherein the reference sample is or comprises a sample from anindividual with a known risk or incidence of colorectal cancer.
 12. Themethod of claim 1, wherein the reference sample is from a population ofindividuals with a known risk or incidence of colorectal cancer.
 13. Themethod of claim 1, wherein the chemotherapeutic agent includesadriamycin, dexamethasone, vincristine, cyclophosphamide, fluorouracil,topotecan, taxol, interferons, platinum derivatives, taxane, paclitaxel,vinca alkaloids, vinblastine, anthracyclines, doxorubicin,epipodophyllotoxins, etoposide, cisplatin, an mTOR inhibitor, rapamycin,methotrexate, actinomycin D, dolastatin 10, colchicine, emetine,trimetrexate, metoprine, cyclosporine, daunorubicin, teniposide,amphotericin, alkylating agents, chlorambucil, 5-fluorouracil,campthothecin, cisplatin, metronidazole, or imatinib.
 14. The method ofclaim 8, wherein determining the level of RNA transcribed from the ABHD2gene, and determining the level of RNA transcribed from the COL10A1 geneand/or the MMP11 gene each independently include performing a northernanalysis, a semi-quantitative reverse transcriptase PCR, a quantitativereverse transcriptase PCR, a microarray analysis, or a combinationthereof.
 15. The method of claim 1, wherein a level of RNA transcribedfrom the COL10A1 gene is increased at least 25% relative to a level ofRNA transcribed from the COL10A1 gene in a reference sample.
 16. Themethod of claim 1, wherein a level of RNA transcribed from the MMP11gene is increased at least 25% relative to a level of RNA transcribedfrom the MMP11 gene in a reference sample.